| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,348.96 | $4,168.69 | $6,918.31 | |
Aetna
| Facility | 50 | $10,000.00 | $10,000.00 | $10,000.00 |
Hometown Health
| Professional | $10.47 | $128.82 | $363.08 | |
United
| Facility | $199.53 | $1,047.13 | $1,995.26 |